Advice/ experience post op pain relief and update

Wobblylegs

Okay so after an arthroscopy in 2009 the reaction I had to Codeine was that after taking only one 30mg tablet I was in A&E on oxygen as it had suppressed my breathing and my heart rate. The Consultant warned me never to go near any Codeine again ever, not even over the counter as 2 tablets would have killed me.

So they know all this at the hospital, before my op, my anaesthetist had written a protocol telling them to try me on Oxycodone (morphine) in tiny amounts in recovery after the op. Then to try me on very small amounts of Pregabalin, I was happy with that as its an epilepsy drug and trying it in hospital meant I could stay on it. Then to try tiny amounts of Tramadol and to increase very slowly and watch my reaction. I don't need very much drug for it to work, ultra sensitive, and too much can cause catastrophic issues for me.

So they give me the highest dose possible of Pregabalin as a pre med? I wasn't worried as I was about to be put under. But something caused me to faint during the spinal anesthesia and weren't not sure if it was the injection or the Pregabalin. Back in recovery they have no concerns Oxycodone seems to be doing ok.

So back on the ward they keep me on Oxycodone slow release every 12 hours with the option to increase to an immediate release tablet if I need it. That seemed fine although a bit spaced out. So then they give me 75mg Pregabalin and 50mg of Tramadol. Tried to get me out of bed on crutches but I felt a bit whoozy and faint, we never thought it might be the meds just me being out of bed. So they checked my blood pressure and that was the same sitting and standing. Went and asked a doctor who said Tramadol doesn't produce a cold sweat so it's not that it must be hyperventilation. Which I accepted, felt too rough to argue.

So later that day they give me a cocktail of slow release Oxycodone, 75mg Pregabalin and 100mg Tramadol. I get out of bed and go to the loo but on the way back start to feel dizzy, go into my usual cold sweat. Lie down on the bed and pass out! I drift in and out for about 3 hours. But doc still says they don't cause a cold sweat!!

So I decided alone to try and manage with no meds except paracetamol! 24 hours later no more cold sweats or fainting sessions and getting on well with a clear head! It was all a joke, they seemed incapable of understanding that I needed meds but in tiny amounts. They just said they didn't have them in smaller doses, so I'm still trying to work out which drug did what to me just for future reference.

Okay to the TKR, yes it's really tough and all the things they tell you. I don't know how long before the pain subsides didn't have a chance to ask. One of the other patients said to me with hips you just need to build muscle but with knees you need to break through scar tissue every day to make progress. So the exercises are ultra painful without any meds, well only paracetamol and ice! I'm Getting about on a frame at the mo (6 days post op) as I couldn't use crutches too unstable with my MS too!

so far it's just rest, exercise, eat, sleep, repeat lol.

Any experiences would be useful, thank you.

barbara12

Blimey you must be scared of getting out of bed, I remeber with my THR having a couple of faitng session when I got out of bed, but soon got back to normal, has for the meds they stick to what they know and thats it, I said I didn't always take my full meds, but they insisted I do, so ended up hiding them.. :roll: going off my hip the first week was the hardest then it was all uphill, hope its the same for you ,wishing you a good recovery

Wobblylegs

I am Barabara but you just have to take deep breaths it's the exercises that are the worst. The Physio said you are one tough cookie to do this without pain relief but I can't see an alternative at the moment!

I'm just interested in how others have coped either with or without the drugs. I'd rather not be a tough cookie as it will put me off having the other knee done!

stickywicket

You are tough. No doubt about it. The monotony of resting exercising, eating, sleeeping etc should continue for some ti, e as the exercises need priority and then the body needs to recover. Post op I use distraction as much as possible to delay the next pain meds - reading, TV, computer games, anything.

I had a similar experience to you after my knee revision. I ended up flaking out, undecorously, on the commode. My BP and oxygen levels were low and urinating does lower BP anyway. I was back to normal next day. Good luck. You're doing really well.

Wobblylegs

Thank you StickyWicket, I think I need that kind of encouragement at the moment. Feeling a bit down and tearful today, 6 days post TKR, so not quite as tough as they think lol.
My fainting was the pain meds, we already knew that it might be a problem before it was done. But we live in hope that this time .......

Wobblylegs

stickywicket wrote:

You are tough. No doubt about it. The monotony of resting exercising, eating, sleeeping etc should continue for some ti, e as the exercises need priority and then the body needs to recover. Post op I use distraction as much as possible to delay the next pain meds - reading, TV, computer games, anything.

I had a similar experience to you after my knee revision. I ended up flaking out, undecorously, on the commode. My BP and oxygen levels were low and urinating does lower BP anyway. I was back to normal next day. Good luck. You're doing really well.

How often did you exercise? I've been told 4 times a day and only 5 of each of 4 exercises initially. But I know others who have done it much more frequently.

Wobblylegs

So any more ideas guys?

Allergic to opioids and can't take NSAIDs as on anti coagulant injections for 2 weeks.

Can I use a TENS machine, anyone done that?
How much is too much on exercising?

Just love some other thoughts on how to get through?

I don't want to end up at 60 with a new knee that doesn't work.

BTW I'm fighting MS too so fatigue and pain are 2 real enemies.

stickywicket

Somewhere I read NICE guidelines on the use of tens for post-op pain. Naturally I can no longer find the article :roll: but I recall the conclusions - that the evidence points to them having some use in conjunction with other methods of pain relief but that the efficacy seems to depend on the type of tens machine, the way it is used amd the points to which the electrodes are attached. It concluded that more research was required.

I suspect there's no one size fits all for the exercises. Certainly I can't recall doing less than 10 repetitions a time of each of my quads and these 6 times daily but remember I don't have MS, was able to take pain relief and have a fairly high tolerance of pain. In your case I'd stick strictly to whatever guidelines the physio had given until further ones were issued When do you see the physio again?

Wobblylegs

stickywicket wrote:

Somewhere I read NICE guidelines on the use of tens for post-op pain. Naturally I can no longer find the article :roll: but I recall the conclusions - that the evidence points to them having some use in conjunction with other methods of pain relief but that the efficacy seems to depend on the type of tens machine, the way it is used amd the points to which the electrodes are attached. It concluded that more research was required.

I suspect there's no one size fits all for the exercises. Certainly I can't recall doing less than 10 repetitions a time of each of my quads and these 6 times daily but remember I don't have MS, was able to take pain relief and have a fairly high tolerance of pain. In your case I'd stick strictly to whatever guidelines the physio had given until further ones were issued When do you see the physio again?

That's useful advice thanks stickywicket, the Physio at the hospital told me to do 5 of each 4 times a day. But the advice sheet they gave me tells you to do each exercise 10 times and as to how often "little and often". So yesterday I upped the exercises to 10 each instead of 5 and I'm still doing them 4 times a day. I think I might slowly try to do 5 times a day as the more I can manage that fits the the 'norm' the better in the long term.

I do have a very high pain tolerance too and so I'm using deep breathing to get through them when necessary. Paracetamol doesn't do much but just takes the edge off.

I don't see the Physio again until Monday! By then I could be struggling more. Staples don't come out until Tuesday though!

dreamdaisy

I feel for you, I am able to tolerate pain relief but stick to my 30/500 cocodamol, I don't have the complication of MS but do share a fairly high tolerance of pain, one of the better things I inherited from my Pa. I have not had a replacement but I did have a huge amount of solidified and liquid swelling removed from my left knee back in 2002, and yes, I could feel the pull and snap as various bits of scar tissue gave up the ghost in the face of the essential exercise demands. This lessened, however, as the days passed. I had on-demand morphine for the first 24 hours but then only paracetamol. It can be done and it sounds as though you are doing OK.

I did not get on well with TENS but others swear by it. It's most attractive aspect is that it is a drug-free treatment and you won't know until you try. These are very early post-op days for you and everyone is different in how they respond to the surgery, in how they heal, in how they do the exercises etc. I know a lady who had a knee replacement but refused to do the exercises because they hurt. She's in a bigger pickle now and blames everyone but herself. Silly moo.

Keep at it girl, you're doing OK. DD

Wobblylegs

dreamdaisy wrote:

I feel for you, I am able to tolerate pain relief but stick to my 30/500 cocodamol, I don't have the complication of MS but do share a fairly high tolerance of pain, one of the better things I inherited from my Pa. I have not had a replacement but I did have a huge amount of solidified and liquid swelling removed from my left knee back in 2002, and yes, I could feel the pull and snap as various bits of scar tissue gave up the ghost in the face of the essential exercise demands. This lessened, however, as the days passed. I had on-demand morphine for the first 24 hours but then only paracetamol. It can be done and it sounds as though you are doing OK.

I did not get on well with TENS but others swear by it. It's most attractive aspect is that it is a drug-free treatment and you won't know until you try. These are very early post-op days for you
and everyone is different in how they respond to the surgery, in how they heal, in how they do the exercises etc. I know a lady who had a knee replacement but refused to do the exercises because they hurt. She's in a bigger pickle now and blames everyone but herself. Silly moo.

Keep at it girl, you're doing OK. DD

Thank you so much DD, in my heart I know you are right, I think what I needed most was encouragement and a virtual hug! So thanks to you and stickywicket that's been achieved

A week today since my op so probably time to give myself a break mentally and get on with the rather physical and painful job of making my new knee work!

stickywicket

I think little and often is the way to go. Doing fewer well is better than doing , ore badly. I hope the physio is happy. To me, you are doing amazingly well.

Wobblylegs

stickywicket wrote:

I think little and often is the way to go. Doing fewer well is better than doing , ore badly. I hope the physio is happy. To me, you are doing amazingly well.

Thank you

dreamdaisy

When you are in the middle of it all it is hard to gauge one's progress but compare yourself to this time last week and Ta Dah! You're further on than then and getting stronger. DD

Wobblylegs

dreamdaisy wrote:

When you are in the middle of it all it is hard to gauge one's progress but compare yourself to this time last week and Ta Dah! You're further on than then and getting stronger. DD

So true DD thank you for reminding me, this time last week I was less than 24 hours post op!

Trouble is there are so many web sites out there that tell you that you should be able to do this, that or the other by #days post op and by my reckoning those that can do most of it must be super human!

I'm doing my 4 exercises, 4 times a day, 10 times each! I'm icing regularly, resting and just taking the occasional little turn around the house. Just too tired a lot of the time to do much as I'm not sleeping well because of the discomfort. On paracetamol and ice only that's not too bad.

Does that all sound very normal, I guess so?

dreamdaisy

Of course there are websites featuring posts and boasts, 'tis now the way of the interweb world. I was a teacher and never understood the word should - humans, whether large or small, will do what they can when they feel able to try and deal with potential 'failure'.

I've never understood why I should compare myself to others because they may not have the troubles I do: I learned that aged 8. How many people have had your kind of surgery plus MS? Do you know? I suspect not. Do what you can do as and when you can do it. I hadn't realised you are home - that's a hugely positive step in itself! DD

stickywicket

You are not 'eveyone'. I know people who have made remarkably quick recoveries from joint surgery but they did not have MS, or an autoimmune arthritis, or, indeed, OA in any other joint. It must make a big difference.

I think you are absolutely right to concentrate on your exerises, resting and icing. The rest can wait. It's not a competition and I'm sure you'll succeed because you have the right attitude and determination.

Wobblylegs

Thanks so much both of you, I know your both right I'm just really hard on myself. Probably as a result of the Complex PTSD I also deal with. Guess everything comes in 3's right?

BTW I came home on Day 5, just 4 nights in hospital, so that in itself was pretty good as they thought it might take me longer. But I was only one day longer than the Enhanced Recovery Programme (ERO) ones.

Our conversation has been the most useful I have had over this, I can't tell you how much I appreciate your common sense approach. When your in the thick of the pain it's difficult to "see the wood for the trees".

Once more thank you from the bottom of my heart.

Day 9 - onwards and upwards.

Huge hugs to both of you xxx

dreamdaisy

In my twentieth year of this nonsense I now employ the 'Onwards and sideways!' approach.

Sticky has had a number of joint replacements, I've had some big ops on my knees (and elsewhere) but no replacements. Between us we've clocked up a fair few miles in operating theatres, recovery rooms, wards, dealing with docs and physios, GPs and well-meaning but idiotic comments from friends and family. The latter can be the hardest to deal with! DD

Wobblylegs

Slosh

I would ask the physio next week if a tens machine would be suitable /helpful. I don't know about replacement joints but I was told I couldn't use one for my neck/arm pain as I have a metal fusion in my neck.

Wobblylegs

Slosh wrote:

I would ask the physio next week if a tens machine would be suitable /helpful. I don't know about replacement joints but I was told I couldn't use one for my neck/arm pain as I have a metal fusion in my neck.

Ooo I never thought of that, thanks Slosh, maybe steer clear until then!
I'm just trying to research pain meds at the moment. It seems that the anaesthetist already had me down as an ultra metaboliser and therefore they should have been a little more careful on the ward, but to late now! :x

Thanks for the tip

Slosh

No problem. When I asked my consultant post op about using one he told me to ask a physio. I know machines can be bought quite cheaply but physios can also advise on where to place the pads and sometimes can loan machines.

Wobblylegs

Slosh wrote:

No problem. When I asked my consultant post op about using one he told me to ask a physio. I know machines can be bought quite cheaply but physios can also advise on where to place the pads and sometimes can loan machines.

No probs there, I already have a TENS m/c, been using it for some time for arthritic changes in my lower back. So it's more a case of can I put it by my new knee? I'll ask Monday.
Thanks again x

stickywicket

Wobblylegs wrote:

Thanks so much both of you, I know your both right I'm just really hard on myself. Probably as a result of the Complex PTSD I also deal with. Guess everything comes in 3's right?

BTW I came home on Day 5, just 4 nights in hospital, so that in itself was pretty good as they thought it might take me longer. But I was only one day longer than the Enhanced Recovery Programme (ERO) ones.

Our conversation has been the most useful I have had over this, I can't tell you how much I appreciate your common sense approach. When your in the thick of the pain it's difficult to "see the wood for the trees".

Once more thank you from the bottom of my heart.

Day 9 - onwards and upwards.

Huge hugs to both of you xxx

No problem, Wobbly. It's what the forum is best at

Wobblylegs

Thought I'd just let you'll know that my first Physio appointment at Day 12 post op today went very well. I have been doing everything right in spite of my doubts. So no extra exercises just carry on doing more of the same. Everything about the knee looks good at the moment.

Staples out tomorrow! Daring to get excited and feel I will get there